The Second Sexual Revolution

Published: February 20, 2000

Correction Appended

(Page 6 of 9)

While cruising the Patent Office's Web site (www.uspto.gov), I discovered that Vivus's claim to prostaglandin E-1 cream has been challenged by a Tennessee doctor named Michael Wysor. According to his patent attorney, Michael Ebert in New York, Wysor may have filed his invention after the original patent was granted to Vivus, but he believes there are technical challenges that support his claim.

Wysor, who ran two sexual-health clinics, in Knoxville and Johnson City, that have since gone bankrupt, has just finished a book proposal on erectile dysfunction. He has tried his cream on women informally, but refused to elaborate on his methods. That's just how crowded the field has become. Garage inventors are in on it.

The pace of change inside this small research world also means that almost no one is stopping to reflect on the implications of the drugs that are marching -- and there really is no stopping them now -- toward the marketplace. When I spoke to Leland Wilson, the C.E.O. of Vivus, about his company's new prostaglandin cream, he happily suggested that most women would be able to experience orgasm after just a few minutes of vaginal intercourse. Such a development seemed fraught with truly significant implications -- both good and bad -- but obviously fraught. When I pressed him to imagine some of the implications, he sputtered through several change-of-subject tactics.

''That is beyond the realm of medicine,'' he said. There was a quality to the conversation reminiscent of Werner von Braun, who supposedly once said, ''I send the rockets up; where they come down is not my business.''

It would be nice if all medical breakthroughs were just for the medical complaints outlined by the doctors. But that's not how the world works. With couples holding down two jobs and the enraged pace of modern life, who doubts that a drug-enhanced four-minute sexual encounter among harried day traders could become the norm? The very idea of a long slow evening probably won't completely disappear. It'll just go the way of sitting on the porch, the 3 o'clock dinner and the literary novel -- something experienced over the holidays or on vacation.

''I find it simply incredible this whole thing is happening,'' said Leonore Tiefer, a psychologist at the New York University School of Medicine and pretty much the only critic of all this research I could find.

''There is no such thing as 'female sexual dysfunction,''' she added. ''It's a social construction invented to benefit the drug companies.'' Tiefer believes that a kind of ''magical thinking'' infects the way most of us imagine our sexuality. That it can always be better, and that we resist the natural changes that define the arc of a well-lived life: ''That's where this disorder comes in and says, 'If there is a change' -- and invariably there is a change in life -- then change is bad.' Ah, a problem! So we invent a universal model, a normative view of sex. If you don't get wet for X period of seconds from Y pressure of stimulation, then you have a problem.''

Tiefer was evasive when I asked her about the existence of real medical conditions being cured by these new drugs. ''What about the placebo effect?'' she asked, when I offered up the Boston professor's case as an example. Tiefer believes the medicalization of sex gives people an out -- a way to avoid the root cause of their sexual problems. ''I don't see many women depressed about the blood flow to the genitalia. They are depressed about many other things about sex, but not that. This research should be done, of course, but with a few dollars, by a few people, in a few places. But it should not be this Boeing of sex research.''

Not surprisingly, many researchers dismiss Tiefer's ideas as rear-guard propaganda to protect the sex concession that therapists have held for so long. Fears that the medical establishment will big-foot the psychologists' business is not an imaginary concern these days. The central theme of Peter Kramer's ''Listening to Prozac'' is the observation that, in the treatment of depression, drug therapy has driven talk therapy right out of business.

''Every disease pharmacology has attacked in the last 50 years,'' Vivus's Wilson said bluntly, ''has at some point been treated by psychologists, and as soon as pharmacology discovers the real organic reason for the disease and a method for treating it, then psychologists moved on to treat something else. That's exactly what's happening here.'' Precisely because ''psychologists have never successfully treated sexual dysfunction in anybody,'' Wilson said, ''business'' was the real source of much of the current professional ''squabbling.'' But not all of Tiefer's critics dismiss her apprehensions.

''There is a fear that Viagra might be used like Prozac,'' Laura Berman said, ''as a sort of Band-Aid approach to therapy. And it's a risk, especially in men, that you might be treating the symptoms, not the problem.''

But Tiefer also believes that the medical model of research is just too reductive: ''They don't look at sex in a robust way. It's the narrowest possible view: does it twitch once or twice? O.K., then, twice is statistically more significant than once. Good girl.''

Correction: April 16, 2000, Sunday An article on Feb. 20 about the proliferation of sexual enhancement drugs in the wake of Viagra, and the resulting competition among firms and inventors, misstated a doctor's involvement in the patent process for prostaglandin E-1, a cream for women. The doctor, Michael Wysor, did not challenge a patent application from a drug company, Vivus. He applied for a patent after Vivus did, but before its patent was granted. Both applicants were granted patents. A letter from the doctor, dated March 10, alerted The Times to the error, and patent research delayed this correction.